Metabolic syndrome and insulin resistance are associated with abnormal left ventricular diastolic function and structure independent of blood pressure and fasting plasma glucose level

Hwang, Yu-Jin; Jee, Jae Hwan; Kang, Mira; Rhee, Eun-Jung; Sung, Jidong; Lee, Moon‐Kyu

doi:10.1016/j.ijcard.2011.02.039

Cited by 56 publications

(61 citation statements)

References 23 publications

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“…19 In particular, the metabolic effects of obesity resulting in dyslipidemia and insulin resistance seem to be the most likely mediators of changes in maternal cardiac function through changes in the composition and material properties of the myocardium. [19][20][21][22][23][24] This assertion is indirectly supported by a recent study demonstrating that Ϸ20% of women who previously had a normotensive FGR pregnancy had features of metabolic syndrome. 25 The endothelial dysfunction is another known mechanism of diastolic impairment 26 and could also play a role in the diastolic abnormalities seen in normotensive FGR, as well as PE pregnancies.…”

Section: Melchiorre Et Al Maternal Cardiac Function In Fgr Pregnanciesmentioning

confidence: 83%

Maternal Cardiovascular Impairment in Pregnancies Complicated by Severe Fetal Growth Restriction

et al. 2012

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Abstract-Fetal growth restriction and preeclampsia are both conditions of placental etiology and associated to increased risk for the long-term development of cardiovascular disease in the mother. At presentation, preeclampsia is associated with maternal global diastolic dysfunction, which is determined, at least in part, by increased afterload and myocardial stiffness. The aim of this study is to test the hypothesis that women with normotensive fetal growth-restricted pregnancies also exhibit global diastolic dysfunction. This was a prospective case-control study conducted over a 3-year period involving 29 preterm fetal growth-restricted pregnancies, 25 preeclamptic with fetal growth restriction pregnancies, and 58 matched control pregnancies. Women were assessed by conventional echocardiography and tissue Doppler imaging at diagnosis of the complication and followed-up at 12 weeks postpartum. Fetal growth-restricted pregnancies are characterized by a lower cardiac index and higher total vascular resistance index than expected for gestation. Compared with controls, fetal growth-restricted pregnancy was associated with significantly increased prevalence (PϽ0.001) of asymptomatic left ventricular diastolic dysfunction (28% versus 4%) and widespread impaired myocardial relaxation (59% versus 21%). Unlike preeclampsia, cardiac geometry and intrinsic myocardial contractility were preserved in fetal growth-restricted pregnancy. Fetal growth-restricted pregnancies are characterized by a low output, high resistance circulatory state, as well as a higher prevalence of asymptomatic global diastolic dysfunction and poor cardiac reserve. These findings may explain the increased long-term cardiovascular risk in these women who have had fetal growth-restricted pregnancies. Further studies are needed to clarify the postnatal natural history of cardiac dysfunction in these women. 1,2 FGR and PE are both also associated with increased risk for the long-term development of metabolic syndrome and cardiovascular disease in the mother.3-9 Acute PE is associated with cardiac remodeling, impaired myocardial relaxation and global left ventricular (LV) diastolic chamber dysfunction.10,11 Furthermore, it is evident that the cardiovascular implications of PE do not cease with the birth of the infant, with a significant proportion of women demonstrating asymptomatic LV diastolic chamber dysfunction and essential hypertension for within 2 years of delivery.11,12 Despite these cardiovascular findings in PE, previous studies of maternal cardiac function in FGR pregnancy failed to identify a clear pattern of myocardial impairment or chamber dysfunction. [13][14][15][16] This is possibly due to the inadequacy of the load-dependent indices used and the interpretation of diastolic measures in isolation, disregarding the interdependency of cardiac events. The aim of this study was to test the hypothesis that women with normotensive FGR pregnancies also exhibit cardiac remodeling and myocardial and ventricular dysfunction, as seen in PE pregnanci...

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Section: Melchiorre Et Al Maternal Cardiac Function In Fgr Pregnanciesmentioning

confidence: 83%

Maternal Cardiovascular Impairment in Pregnancies Complicated by Severe Fetal Growth Restriction

et al. 2012

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“…As insulin resistance has previously been demonstrated to be associated with LVM [26,27] and the development of heart failure [2], and resistin promotes myocardial insulin resistance [9], an important consideration of the present study is whether relations between circulating resistin concentrations and LVM or dysfunction are mediated through insulin resistance. In this regard, in the present study HOMA-IR was independently associated with increases in LVMI and LVM inappr , but not FSmid.…”

Section: Discussionmentioning

confidence: 95%

Independent associations between resistin and left ventricular mass and myocardial dysfunction in a community sample with prevalent obesity

Norman

Norton

Libhaber

et al. 2015

International Journal of Cardiology

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“…It has been reported that patients with elevated SUA are more likely to have increased insulin resistance or metabolic syndrome (18). In addition, subjects with metabolic syndrome are more likely to have diastolic dysfunction (9,17), and this association may be stronger or present exclusively in women (22,24). More recently, Nagayama et al (29) reported that cardio-ankle vascular index, a marker of arterial stiffness, was associated with SUA level in both sexes; however, an increase in cardio-ankle vascular index was observed for a lower SUA range in women compared with men (29).…”

Section: Discussionmentioning

confidence: 99%

Serum uric acid is associated with cardiac diastolic dysfunction among women with preserved ejection fraction

Nogi

Fujita

Okamoto

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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N. Serum uric acid is associated with cardiac diastolic dysfunction among women with preserved ejection fraction. Am J Physiol Heart Circ Physiol 309: H986 -H994, 2015. First published July 25, 2015 doi:10.1152/ajpheart.00402.2015.-Serum uric acid (SUA) is associated with the severity and prognosis of systolic heart failure. We investigated the potential association between SUA and cardiac diastolic dysfunction among total of 744 cardiac patients (202 women and 542 men) who had preserved left ventricular ejection fraction. Presence of diastolic dysfunction was assessed by echocardiographic data, plasma B-type natriuretic peptide concentration, and left ventricular hypertrophy. Univariate analysis showed that the prevalence of diastolic dysfunction increased with increasing SUA value in women, but not in men. When sex-nonspecific SUA quartiles were used, multivariate logistic regression analysis, among female patients who were not taking uric acid lowering medication, showed that the third (SUA, 5.7-6.4 mg) and the fourth (SUA, Ն6.5 mg/dl) SUA quartiles were associated with diastolic dysfunction with an odds ratio of 3.25 (P Ͻ 0.05) and 8.06 (P Ͻ 0.001), respectively, when compared with the first SUA quartile (Յ4.7 mg/dl). When sex-specific SUA quartiles were used among these population, multivariate logistic regression analysis showed that the fourth SUA quartile (Ն5.7 mg/dl) was associated with diastolic dysfunction with an odds ratio of 5.34 (P Ͻ 0.05) when compared with the first SUA quartile (Յ4.1 mg/dl). By contrast, the relationship between SUA and diastolic dysfunction was not significant in men, irrespective of which of the sex-nonspecific or sex-specific SUA quartiles were used. These data indicated that among cardiac patients with preserved ejection fraction, SUA was significantly associated with diastolic dysfunction in women but not in men. ALONGSIDE THE AGING POPULATION, the prevalence of heart failure with preserved ejection fraction, or diastolic heart failure, is increasing, and this increase is more prominent in women than in men, who demonstrate striking disparity with regard to heart failure with reduced ejection fraction (2,3,25). This disparity might be explained by the fact that aging-associated concentric ventricular remodeling is greater in the female heart (35). In addition to sex difference, several clinical characteristics are known to be associated with heart failure with preserved ejection fraction including older age, hypertension, obesity, diabetes, and potassium concentration (23). The prognosis for diastolic heart failure may be as poor as that for systolic heart failure (11, 31), and most therapies that have been shown to be effective for systolic heart failure seem to be least effective for diastolic heart failure (11,15,26,32,42). Thus factors that are not only related to diastolic dysfunction risk but also potentially modifiable by lifestyle interventions or certain medication need to be identified for the better management of diastolic cardiac dysfunction, especially in wom...

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Metabolic syndrome and insulin resistance are associated with abnormal left ventricular diastolic function and structure independent of blood pressure and fasting plasma glucose level

Cited by 56 publications

References 23 publications

Maternal Cardiovascular Impairment in Pregnancies Complicated by Severe Fetal Growth Restriction

Maternal Cardiovascular Impairment in Pregnancies Complicated by Severe Fetal Growth Restriction

Independent associations between resistin and left ventricular mass and myocardial dysfunction in a community sample with prevalent obesity

Serum uric acid is associated with cardiac diastolic dysfunction among women with preserved ejection fraction

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